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2  This following information is available for you to review at any time on our website at:

3 Forearm strap – helps to keep elbow deep in sling. Neck Clip Thumb strap- OK to use this as shown or not use based on comfort. Keep forearm parallel with floor.

4 Most patients will feel that keeping their arm and sling more in front of their body versus out to the side feels better.

5  Sling should be worn at all times except with bathing for first 6 weeks, unless instructed by your physician or therapist.

6  During showering or bathing use a 2 liter pop bottle or rolled up towel in a zip-loc bag to keep your elbow away from your side.  For some patients your physician or therapist may allow you to shower with your arm down at your side and no pillow.

7  You should support your arm with pillows when sitting at home or in a car.  Once supported with pillows it is then OK to undo the neck strap while sitting to give your neck a break.

8  ONLY use your non-surgical arm to help adjust the sling position. Your surgical arm should be relaxed at all times.

9  As soon as you are home and there is minimal drainage it is OK for you to remove all of the dressings and cover your stitch sites with band- aids only. This will allow the ice to have a better impact on pain and swelling.  Your stitches will be removed between 10 days and 2 weeks after surgery by the Physician Assistant or Physical Therapist.

10  We recommend that you ice your surgical shoulder at least 4-5 times per day for 20 minutes. You may ice your shoulder as often as 20 minutes every hour for pain control if needed. You should plan to ice for at least 4 weeks.

11  Always keep one layer of fabric between the ice pack and your skin to prevent frost bite.

12  Prairie Shoulder, Elbow and Hand Center does have ice packs available for purchase.  Homemade Ice Packs: In a doubled up zip-lock bag, place 2 parts water and 1 part rubbing alcohol. Place in freezer. The ice pack will freeze slushy and can be applied to shoulder and re- frozen. Make sure to place a layer of fabric between the ice pack and your skin.

13  Dr. Hurlbut will prescribe pain medications for you when you leave the hospital. If you need a refill of your pain medications please let the pharmacy know as soon as possible.  You should not wait until you are completely out of medication to call your pharmacy as it may take a day or two to complete medication refills.

14  Pain medications may cause minor side effects such as nausea, itching, and constipation. Do not be alarmed by these symptoms. If the side effects are not tolerable please contact your physician to discuss other options.  Make sure to use a stool softener each day that you use prescription narcotics to prevent constipation. Ask your pharmacist for an over the counter stool softener or use Milk of Magnesia or prune juice if you prefer.

15  It is OK for you to use Over the Counter pain medicine such as Ibuprofen or Aleve at the same time as your prescription pain meds. These types of medications do not interact.  You should follow the dosage instructions on the bottle and only take these Over the Counter medications as long as your Primary Care Physician is in agreement that they are healthy for you.

16  Many of the prescription pain medications contain Acetaminophen (Tylenol). Therefore you can not take any additional Tylenol when taking narcotics that already have acetaminophen (APAP) in them.  If you skip a narcotic dose it would then be OK to substitute Tylenol for pain if you prefer.

17  It is OK for you to get your shoulder and the stitches wet as soon as 3 days after surgery.  Do not soak your shoulder under water, just let the clean water run over the stitches and pat dry it with a towel.  Don’t forget to use a 2 liter pop bottle or rolled up towel under your arm to keep the arm from resting against your side.

18  You should lean over at the waist and allow your arm to naturally fall away from your side to gain access to wash under your arm or to put on deodorant or dry your armpit.

19  Many people find wearing button up shirts easier to get off and on the first few weeks.  Bending forward at the waist and letting your arm naturally fall away from your side will allow greater ease of getting a sleeve on.

20  Whether you wear a pull over or button up shirt, you should always lean forward and place your surgical arm into the sleeve first, then either pull it over your head or place non-surgical arm in next. Your surgical arm should always be relaxed at your side.

21  Pull on pants are helpful the first couple weeks, as buttoning or snapping pants at the waistband will be difficult for your surgical arm.  You will not be able to use your surgical arm to pull on socks or put on or tie shoes for several weeks.

22  Many people find they are unable to sleep lying down flat on their back in bed for several weeks to several months following their surgery. It is OK to lie in bed if tolerated.  You should plan to sleep in a reclined position with pillows to support under your forearm and behind your shoulder to help position it in the most comfortable way.

23 When resting in a chair or recliner you should use pillows under your sling to support the weight of your arm. It is OK then to use your non-surgical arm to take your surgical arm out of the sling and lay it on a pillow to stretch your elbow straight for awhile. Just hook your sling all back up when you are ready to get up and move around again.

24  If you want to lie down for awhile in bed you will need to place a rolled towel or pillow behind your arm to keep your elbow off the bed for support and to decrease pain.

25  It is Ok to return to sleeping in bed whenever your are comfortable to do so.  You can not sleep on your surgical shoulder for at least 3 months and maybe longer depending on pain.  Some people find that sleeping on their non- surgical side on the couch gives them some relief from constantly being in a recliner.

26  Your physician recommends PT for your shoulder 3 times per week for the first 6 weeks. After six weeks most patients are able to decrease to 2 times per week for 6 weeks and then 1 time per week for 4-6 weeks.  Most patients will be in therapy for approximately 4 months and about 35 total visits.

27  Please contact your insurance company eligibility and benefits department to determine if you need prior authorization for Physical Therapy.  You will need to know if you have a limited number of visits per year and whether or not you have a copay due each visit or not.  Let your therapist know if you have a limited number of visits as soon as possible.

28  Please remember that it is always your option to receive Physical Therapy at which ever clinic you prefer.  If you would like to receive PT at our clinic the front desk staff will assist you is setting up your appointments.

29  Physical Therapy appointments at our clinic will take approximately 45 minutes to 1 hour.  You do not have to worry about wearing any special clothing to therapy.  Some people prefer to schedule their pain meds in order to take them approximately 45 minutes prior to their session to help them better relax.

30  It is always better to schedule your appointments for several weeks in advance depending on your preferred therapy schedule.  If you prefer to receive PT at another clinic please let the front desk staff know and they will provide you with a prescription from Dr. Hurlbut to go elsewhere.

31  Your therapist will instruct you on your home exercises based on your specific surgery.  It is important to watch your posture despite being in the sling.  Sit up straight  Keep shoulders back  Don’t slouch, use pillows to support the weight of your arm.

32  You should not try to lift your arm away from your side or up in the air above shoulder height for at least 10 weeks, unless instructed by your PT.  You should be very careful to relax your shoulder in your sling and not hold your shoulder up in the air by your ear. RELAX in the sling and let the neck strap support the weight of your arm.

33  Lifting Precautions  1 pound for the first 3 months for all lifting, pulling, pushing and carrying with the surgical arm  5 pounds between months 3 and 4  10 pounds between months 4 and 5  20 pounds between months 5 and 6  No restrictions after 6 months  These precautions can vary depending on the type of surgery.

34  You should not drive while taking prescription narcotics. This would be considered as “driving under the influence” and is illegal.  You may return to driving when you are no longer using narcotics prior to 6 hours before driving and when you feel comfortable to do so.  Many people find it difficult to drive until after 6 weeks when they no longer are wearing the sling.

35  You will need to follow up with the Physician Assistant at 2 weeks post-op for stitch removal, medication refill, and to get a work note if needed.  You should then follow up with the Physician at 6 and 12-weeks post-op as well in order for them to determine you are progressing appropriately.  Please call our office to schedule at any other times should you have any concerns.

36  Please call our office at any time if you should have questions.  You should call us immediately should you develop a fever or notice increased redness or any drainage around your incisions after 3 days.  402-489-4700

37  This information is available for you to review at any time on our website at:

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